Post-Emergency Optimization of Antibiotic Therapy for Urinary Tract Infection (UTI) (REVIU48)

Post-Emergency Optimization of UTI Antibiotic Therapy: "Fluoroquinolones and Third-Generation Cephalosporins Under the Spotlight"

Prospective, multicenter, non-interventional study conducted over 6 months, including patients presenting to the emergency department with suspected urinary tract infection managed as outpatients and discharged with or without empiric antibiotic therapy.

Discharge antibiotic prescriptions are reviewed, with subsequent reassessment and optimization of treatment based on urine culture and susceptibility results

Study Overview

• Status: Not yet recruiting
• Conditions: Urinary Tract Infections; Emerging Infectious Disease; Antiobiotic Stewardship
• Intervention / Treatment: Other: Adaptation of antibiotics therapy for outpatient urinary infection following emergency care

Detailed Description

Urinary tract infections are a frequent cause of emergency department visits, accounting for substantial antibiotic use. Data from the OSCOUR (Organisation de la Surveillance Coordonnée des Urgences) network estimate around 5,000 weekly visits. Resistance rates among Enterobacteriaceae in urine samples are particularly high, largely driven by the widespread use of broad-spectrum antibiotics, especially fluoroquinolones, which are commonly prescribed as empiric therapy. Given their potential for serious adverse effects and their strong selective pressure for resistance, stricter control of their use is warranted, yet remains insufficient.

In current emergency practice, conditions such as pyelonephritis or male urinary tract infections are often treated with broad-spectrum antibiotics that are continued even when pathogens are susceptible to narrower agents. De-escalation to narrower-spectrum therapies would help preserve the microbiota and limit resistance.

This study is a prospective, multicenter, non-interventional observational study conducted over 6 months. It includes patients presenting to the emergency department with suspected urinary tract infections managed on an outpatient basis and discharged with or without empiric antibiotic therapy. Antibiotic treatments are reassessed 48 - 72 hours after inclusion by a physician, allowing for patient follow-up and potential modification of the initial prescription based on urine culture and susceptibility results, in accordance with current guidelines.

The study aims to assess the value of this reassessment strategy in improving antimicrobial stewardship for urinary tract infections in emergency settings and to inform future optimization of clinical practices.

• Study Type: Observational
• Enrollment (Estimated): 330

Contacts and Locations

• Study Contact: Name: Anna BELKACEM, MD; Phone Number: 01 43 86 21 62; Email: anna.belkacem@chiv.fr
• Study Contact Backup: Name: Wissem TOUADI, Resident; Email: wissemtouadi@gmail.com

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: No

• Sampling Method: Non-Probability Sample

Study Population

Inclusion of patients presenting with suspected outpatient urinary tract infections, to the emergency department

Description

Inclusion Criteria:

• Age 18 years or over
• Patients presenting at emergency department, with symptoms suggestive of a urinary tract infection suitable for outpatient management (uncomplicated cystitis or cystitis at risk of complications, uncomplicated pyelonephritis or pyelonephritis at risk of complications, male urinary tract infection with or without fever) who have had a urine culture taken

Exclusion Criteria:

• Refusal to participate in the study
• Vulnerable person (person under guardianship or trusteeship, minor, person deprived of liberty, person unable to express their refusal)
• Pregnant women
• Severe urinary tract infection (sepsis, septic shock or requiring drainage, except for low urinary catheterisation)
• Hospitalisation for a urinary tract infection or decompensation of another comorbidity
• Suspected urinary tract infection without a urine culture having been performed

Study Plan

How is the study designed?

Number of groups / cohorts

1

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Suspected of outpatient urinary tract infection; Inclusion of patients with outpatient urinary tract infection in emergency department	Other: Adaptation of antibiotics therapy for outpatient urinary infection following emergency care; Re assessment of antibiotic therapy at 48 hours based on urine culture results : discontinuation or de-escalation to a narrower-spectrum agent

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Time Frame
Assess changes in fluoroquinolone and third-generation cephalosporin prescribing in outpatient urinary tract infections following adjustment based on urine culture and susceptibility results.	At 48 hours - 72 hours after the patient inclusion

Secondary Outcome Measures

Outcome Measure	Time Frame
Incidence (percentage) of adverse effects associated with antibiotics.	At 1 month after the consultation in the Emergency department
Incidence (percentage) of antibiotic prescription savings in the Emergency department for outpatient urinary tract infections (cessation of prescription, shortening of treatment duration and/or narrowing of the spectrum) following the intervention	At 48 hours - 72 hours after the patient inclusion
Assessment of patient satisfaction with medical follow-up via a question asked directly to the patient via a questionnaire (Better if more than 50 percent of patients are satisfied)	At 1 month after the consultation in the Emergency department
Assessment of patients' knowledge of antibiotic resistance via a question asked directly to the patient via a questionnaire (Better if more than 50 percent of patients are satisfied)	At 1 month after the consultation in the Emergency department

Collaborators and Investigators

• Sponsor: Centre Hospitalier Intercommunal Creteil

Study record dates

Study Major Dates

• Study Start (Estimated): June 1, 2026
• Primary Completion (Estimated): January 1, 2027
• Study Completion (Estimated): January 1, 2027

Study Registration Dates

• First Submitted: April 9, 2026
• First Submitted That Met QC Criteria: April 23, 2026
• First Posted (Actual): April 30, 2026

Study Record Updates

• Last Update Posted (Actual): May 12, 2026
• Last Update Submitted That Met QC Criteria: May 7, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Urinary tract infection; Urine culture and sensitivity tests; Antimicrobial stewarship; Side effect and adverse event of antibiotics; Fluoroquinolones and 3rd-generation cephalosporins
• Additional Relevant MeSH Terms: Urogenital Diseases; Pathologic Processes; Male Urogenital Diseases; Urologic Diseases; Female Urogenital Diseases; Female Urogenital Diseases and Pregnancy Complications; Disease Attributes; Infections; Communicable Diseases; Pathological Conditions, Signs and Symptoms; Urinary Tract Infections; Communicable Diseases, Emerging
• Other Study ID Numbers: REVIU48

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: NO

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No